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Our Decision to Switch to Medtronic Minimed 630G Insulin Pump – Part 2

This part may be a bit long, so go get some coffee and settle in. There is a lot to cover here ūüôā

Ahhhh….coffeeeeeee…. (Pixabay)

I started on the Medtronic 630G pump on 5/1/17 – the day I received it. This is a bonus of having a small endo office – they can pretty much work you in at any time for device training.

So, in the boxes were the pump box, sensor box, and meter box. Along with lots of papers and training books. I had also already watched the training videos and played with a demo too, so I had a general idea of what to expect.

Using the pump wasn’t my concern at all since it worked pretty similar to other pumps — it delivers insulin based on your settings. Okay, no biggie. The biggie for me was whether I could trust the CGM or not. This is a big question for many, especially if you are die-hard dedicated Dexcom user as well.

See, I had the 530G before with Enlite. I did not have good success at all. It was rarely correct, and I was going through sensors every 3 or so days. It wasn’t worth the hassle it was giving me. But, I had been keeping my eye on the 630G since it was available, and I wanted to see what other’s were experiencing. The consensus was that the 630G was much better somehow. I believe they updated the algorithm a bit, and it was supposed to be a vast improvement.

The game-changer that helped the transition:

I made the decision that others had (CarolCluka and CoolReeRee ) to keep my Dexcom sensor attached until I was fully comfortable. This lasted about 3 weeks. I kept my Dexcom connected to my Glooko account because I can connect Glooko to Medtronic Carelink, and I could see how they both compared. I was pleasantly surprised, to say the least:

Of course, there are times when the sensors didn’t line up perfectly, but as you can see, they’re pretty on-point with each other.

I’ve had pretty good success, and so much that I disconnected from my Dexcom after 3 weeks and felt completely comfortable doing so.

The good, the bad, and the tips…

Now, let me tell you… it hasn’t been all cupcakes and rainbows for the last almost-two-months. I did go through about a week or so of wildly inaccurate¬†readings. So much that I reconnected my Dexcom. See, the problem is that you cannot jump into the Medtronic system with the experience of Dexcom. You have to wipe that mindset out and start over.

First and foremost, you have to calibrate at least twice a day, but it is recommended to be 3 times at a minimum, and 4 max. So, I’ve developed a routine – I calibrate when I wake up, again before lunch, and before bed. The system stays pretty accurate if I do that, which is no problem really, because it’s not hard to do. I’ve never been one to feel comfortable enough to dose off of my Dexcom, so I always test before eating. All it takes is a click to calibrate, and then a click to go to the bolus wizard. No big deal at all.

Second, there are rules:¬†(I’m sure they could apply to Dexcom too to help make it be more accurate, but these are sort of a must-follow in my opinion if you are on Medtronic’s system)

  1. Follow the “B” rule when learning your own calibration schedule: Before breakfast, before lunch, before supper, before bed. Find three of those that fit YOUR schedule and when you know you’ll be least likely to be trending wildly (aka – no arrows)
  2. Do NOT calibrate if you have bolused in the last 2 hours. The sensor is less likely to be as accurate since you have bolused in that time, and a calibration could confuse the sensor.
  3. If the sensor is “off”, especially when waking up first thing in the morning, try drinking some water and walk around a bit. This gets the interstitial fluid moving around the sensor again. It will likely re-align itself within 30 minutes or so.
  4. Be patient. I cannot stress this enough. If coming from Dexcom, you may be used to the instantaneous calibrations.¬†The sensor can take 10-15 minutes to accept a calibration, especially if the values are very different (up to 60mg/dL). If it is above 60mg/dL, try the drinking and walking bit. If it doesn’t realign, call tech support for help or a new sensor. They can help you upload your pump and look for specific things that could be interfering with the sensor communication.
  5. When inserting the sensor and taping, BE GENTLE! Taping the sensor head down too hard or pulling the transmitter tape flap too hard and tight on top of the transmitter can cause the sensor to pull out just a bit from the skin, which can cause big trouble. If you set it up softly, it will be nice to you.

After I called tech support, I found that I was being too rough with taping, and not being patient with the calibrations. Since then, I’ve been able to go back to Enlight sensor values only, and it’s been just as good as it was when I first started. Heck, it’s even caught real, legit lows that the Dexcom didn’t.

In the past couple of months, I have been greatly impressed with the CGM of the Medtronic 630G pump. I’ve caught myself at times in awe of it, really.

Why the 630G now and not wait for the 670G?

One question I was asked already on Facebook was “why not wait until the 670G?” The reason is that I wasn’t sure I could trust the sensor to make the call to give me insulin if I were going above range. Cutting off my basal for a couple of hours is one thing — giving me insulin when I don’t need it is a whole other realm, and I wanted to be sure I could trust the system. I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program).

I am on the list for the 670G, and I should be able to get it next month once my sensor order is due (that’s how they time when you get it if you’re on the pathway program). I can use the pump similar to how the 630G works now when I get it, and then wait to be trained on “auto-mode” later. I am cautiously excited to see how it works, but I’m also not going to be entirely upset if it doesn’t live up to the hype I’ve seen. Mostly, because I know the experience is going to be different for everyone, and I know it can be a learning curve even if you’re coming over from the 630G.

And, to be completely honest, it would be the same hesitancy whether it was the Medtronic system or one that incorporated Dexcom. Anything that augments how my insulin is delivered, I’m going to be very hesitant about. I guess I’m just old-fashioned and have been burned by eagerness one too many times.

Where to view more if you’re interested:

I’ve been trying to keep this to myself and a few close friends in the beginning just in case this new experience caused me to be upset and disappointed. I prepared myself for the worst, thinking it would be no different than the 530G. Maybe that’s why I’m so much more surprised than I thought I would be.

So, instead of blowing up their phones with text or Facebook messages, I decided to revive my Sugar and Sites domain for Instagram and Tumblr, and get my thoughts out there.

You can click on the image and it will take you to the Instagram page I’ve been using. Let me know in the comments what you think, and if you have any other questions. From those, I’ll make a Part 3.

Which brings me to my next thought: I may begin transitioning from Sugabetic to Sugar and Sites overtime. I’ll still keep Sugabetic alive, but maybe on a free WordPress site. I’ll handle the transition as smoothly as possible, but there may be a few days that things will be down. Until then, feel free to follow me on IG for updates about the pump experience ūüôā¬†

 

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Why a CGM is Important to Me

I didn’t know I was low.

I was sleeping peacefully.

My Dexcom started alarming that I was low, but somehow in my brain I just knew it was wrong. I had no symptoms. No rapid heartbeat. No sweat. No confusion. No anything.

If I hadn’t had the Dexcom, I don’t know if I would have woken up.

I am a firm believer that a CGM system should be standard of care with any diabetic taking insulin. When I had tighter control, I had hypoglycemia unawareness, but now that I’m a bit more relaxed, I’m usually able to catch the lows in the 60’s. But not this time.

All it takes is one time.

One time to not feel it.

One time to not have symptoms.

One time to not wake up. 

I’m ok now, just dealing with the aftermath with a low-induced headache and feeling overall draggy today (both from the low and my daughter who is my little night owl / early bird). But times like this? Rock me to my core. It’s times like this that make me wonder and think of how insurance companies can deny, any diabetic on insulin who has been prescribed this device, access to it. It shouldn’t be their call. Something needs to be done.

CGMs shouldn’t be considered a luxury item – they should be as standard as a glucose meter itself.

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Dexcom G5 – A Month Later

So, I’m finally getting to write some of my thoughts around the Dexcom G5 Mobile system. While I do see it as an upgrade to the G4, I don’t see it as a must-have.

Unlike when we went from the Seven+ to the G4, there wasn’t a huge hardware change other than the transmitter is now Bluetooth and can talk to a phone without the constant need of a receiver. However, notice I said “constant” need. There are times when the phone seems to not pick up signal very well for me, even when I’m holding my phone not even 2 feet away from the transmitter. Other times, it’s great at picking up signal. Mostly, I lose signal at night, so I keep my G5 receiver by my bed or in my bed with me. Otherwise, I will take it with me if we’re going on a long trip just so I know if my phone dies, I have a backup. I tend to stash it in my bra under my arm in the band so it has a comfy home. I’m used to storing my pump there when I wear a dress, so it’s no big deal to keep it there too.

On the side of whether or not the signal length is shorter or longer, technically, they both were rated to have signal for up to 20 feet – however, the G4 seemed to get much greater distance than that. I guess I got spoiled. Now it seems I have to almost always have my phone attached to my hand or butt (it stays in my back pocket mostly).

It is pretty nice to be able to have my Dexcom in my phone though when I have to make a quick trip somewhere – just grab the phone, ID and debit card and go.

And I like that when I calibrate on my phone, it carries over to the receiver when I get in range of it. No need to calibrate both devices, and both devices also show the same sensor glucose value. Now, with that being said, I wish that they synced missing data between the two when they were in range. So, if I’m out of range of my receiver for a while, it would fill in gaps from my phone.. and vice-versa.

I almost miss my G4 at times, simply because I don’t like having to use the Follow app to view the data on my Apple watch. I like that there is a separate app for the Share2 app. It seems they could make the Share2 app fill-in the gap like it used to do when the receiver was out of range and then brought back in range for the G4.

I ran both the G4 and the G5 side-by-side for a week as many were stating they felt they were getting better accuracy (Need a diabetes device¬†guinea¬†pig? Call¬†me!). I even did myself. But, after watching it on both screens and calibrating with the same numbers, they were both relatively the same over time, so I don’t really feel one was more accurate than the other (unless you were going from the pediatric version of the G4, which did not have the 505 software, to the G5 which does – then, yes, I could see that being more accurate).

As far as the Clarity app, I still don’t like it. But, one thing I saw a lot of people having an issue with was the Estimated A1c and feeling that it could be off from their actual A1c. Two things come to mind with this – 1) they’re not really supposed to exactly match because what Clarity gives you is a rough estimate based on your sensor average… which leads me to…

2) (yes, I feel I need a separate paragraph for this one) Your estimated A1c and estimated sensor average are only going to be as accurate as your meter. I know, I know, a lot of people say that if the FDA approved it, it’s accurate enough. I call baloney. I’ve done my own testing of several meters on the market, as well as several other people, and I’ve read many different charts with statistics of different meters available, and I personally have chosen the Bayer Contour Next line of meters for my own peace of mind. Why? It’s not about testing them against each other with the same drop of blood for me, but how they test when ran two or three times back to back. If I have a meter that runs numbers of 136, 178 and 154 in succession, then I tend to raise an eyebrow. However, if I find one that runs 136, 131 and 138 in succession for three drops, it tends to make me feel more confident about the readings that meter is giving me when testing just one drop for a bolus. Out of all of the ones I’ve tried, the Contour Next brand worked better and had tighter deviations, so it’s what I’ve stuck with. But, as always, I’m not a medical doctor or medical scientist, so my own thoughts and testing are simply to appease me. Don’t take my word for it – if you’re curious, do your own testing and research.

And, back to Clarity and the A1c Estimation and the actual A1c correlation… here’s mine:

Clarity vs actual A1c

All in all,¬†the G4 is still a good, solid, reliable product. The G5 is more a convenience system that gives you options. And options are good. ūüôā

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First Week With Dexcom G5 Mobile

G5 is here!After waiting 2.5 months, I finally received my upgrade transmitters for the Dexcom G5 Mobile system. To say that I was excited is an understatement. The thought of not having to carry around a receiver was pure bliss because honestly, I didn’t think I could lose my brain anymore than I did after my first kid and I was wrong – I literally could not find my nose if it weren’t attached. The balance of keeping order of all-things-diabetes in my life went out of the window, so I was leaving that receiver more places than ever. And if I kept it in my pocket, I would have that, phone and pump in various pockets and feel a bit tool-belt-ish.

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It’s true. Having my phone act as my receiver is liberating. I love only having to keep up with my phone. And my house is sort of small, so I can leave it in one central location most of the time and get signal most everywhere. But most of the time I have my phone with me for email, text, and baby-photo-op reasons, so that’s not an issue. The issue used to be that I was never near the receiver when the alarm sounded, and it would be at the most inconvenient of times, so it would get called all sorts of names and I would end up more frustrated than thankful most of the time. Now, it’s always with me since it’s built into the phone. Awesomeness.IMG_1169

The biggest thing I love about the app is now I can easily just tap in my BG calibration (NO SCROLLING – YAY!), and most of the time, I log my carbs and insulin now too. The app makes it easy to do, and seeing that blip helps. I also have used it to log my breast-pumping sessions so that I can figure out a better way to handle how it affects my BG by logging it as “light exercise”. I also like that the alert is shown with the actual BG number, not just “BG above ###”.

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I also love that my data is automatically stored into Dexcom Clarity, and accessing my report is as simple as opening the app, clicking a button, and viewing¬†it. I can then email it to myself for in-depth review or just quick-glance over it when I have a couple of seconds free that I haven’t passed out from exhaustion.

Now, for the things that I don’t like or feel “meh” about:

The super private alert system. I think this is an area that should fall under “give us the ability and let us choose”. Personally, if I am being alerted of being high or low, I want to know what that alert number is WHEN I’m alerted, and not have to fumble with unlocking my phone first then opening the app. I want it to be an option that I can CHOOSE to turn on or off to see in that alert either “High Glucose Alert” or “High Glucose Alert – ###mg/dL”, and give us the option to open the app or dismiss the alert… which leads me to….

AW Alert

FOR HEAVEN’S SAKE PLEASE ALLOW US TO *ACTUALLY* DISMISS THE ALERT FROM WEARABLES OR EVEN THE LOCK SCREEN WITHOUT OPENING THE APP! This is my biggest pet peeve. If the above issue is solved where I¬†choose¬†to see my BG number and arrow within the alert, then also actually let me dismiss the alert when notified without having to open the app. I like the alert that comes up when you open the app, but it’s sort of pointless to me because I’m opening the app BECAUSE I’ve been notified, and I’m sure I’ll see the number once it’s open – no need to show a splash screen of sorts with it on there. I needed that BEFORE opening the app.

And along that same line – if I dismiss the alert from my watch, I shouldn’t still be notified every few minutes still from my phone. Especially since I’m required to have both the G5 mobile app and the Follow app to see it on my watch, and getting multiple alerts bugs the heck out of me. I get that the goal is to be sure to check the actual device for stale data, etc, but one would probably be keen to check if their BG remained static for hours on end.¬†Heck, even instead of “dismiss”, let it be a “snooze” where you aren’t alerted seemingly every minute until you dismiss the actual alert. I would rather be able to “snooze” the alert for 10-20 minutes if needed rather than having that useless “Dismiss” option.

Follwing Friends

Overall, I like the Dexcom G5. I think it’s a big improvement, but I also think it’s a big step back. The jist of it is – let us *actually* dismiss from wearables, give us a separate app for those wearables for G5 (NOT the follow app for those of us who use it for ourselves and to follow others [which doesn’t sound creepy at alllll, right?]) (update: I hear there is a G5 mobile app for the Apple Watch in development, it just wasn’t ready when the G5 was approved by the FDA), and for all things mobile – LET US CHOOSE if our BG alert actually shows the BG or not.

I’m hoping to find a work-around until the G5 Mobile app comes to the Apple Watch since I have to use Follow currently. Possibly using only the alerts through the Follow app and turning off G5 Mobile alerts and simply using the G5 Mobile app as the loader? HHmm. I need some thought time on that one.

Check back later for an update! I’ll soon have my G5 receiver (I chose not to update my G4 one to use as a spare for the G4 transmitter), and I’m sure I’ll have some comments about that when I get it!

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Coordinating Devices with PumpPeelz

One little thing I like to do is design graphics. I piddle with it, mostly, so it’s not a big thing, but it gets my creative juices flowing and takes my mind off of other things that may be stressing me out.

So, I wanted to make a design to get a custom PumpPeelz made so that my Dexcom and Medtronic pump matched and looked cute. Crazy, I know, but that little bit of color and art makes having the devices not so mundane. So, I set out to make a design using a blank canvas in Photoshop and some “brushes” (some of them are more like stamps, like the ones I used). I also used color inspiration from my niece’s favorite show, Strawberry Shortcake. My favorite character is Cherry Jam because, well, she sings and her colors are pink (like, fuchsia pink), a purpley-tinged pink, white and purple. This is where I LOVE Adobe Color because I can pull the exact colors from the photo and use them in my design work in Photoshop. (okay, okay, enough about my geekiness…)

Scott was able to take my image that I sent him:

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And with it, he was able to make my matching skins:

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I love them. ¬†And the purple almost matches the color of the pump too. And, since I really don’t like the pink that the Medtronic pumps come in (someone likened it to a naked mole rat once, so now that’s all I see with it!! hahaha!), this gives me a perfect mix of purple AND pink… a pink that I like.

Is this post about diabetes? Not necessarily. But I do believe that things that make us happy and creative around diabetes helps us to do better and be more encouraged to take better control of ourselves. And if a silly pump skin or Dexcom skin helps do that and also gives me a means to display my artwork, then hey, it’s all good. ūüôā

So go and get creative. If we have to use these things to help us be healthy, why not get creative with them? No use in being drab all of the time, I say. (Unless that’s your thing… if so, go for it.)

 

If you like this design too and would like to have one like it, feel free to email me and I can let Scott know that you would like to purchase one. I don’t charge for the designs, so it would be the cost of a custom designed skin from PumpPeelz.

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Conflicted

I am one of MANY people who choose to use the Medtronic pump system with the the Dexcom CGM system. Since¬†my endo took me off of my t:slim, the biggest thing I have been irritated by is how I cannot get all of my information into one report. I was finally SO happy to have that ability with Diasend for the t:slim and the Dexcom, and now I don’t. I know Medtronic has their own CGM system and I do have the 530G that will work with the Enlite sensors, but I had a bad run of luck (about 3 months worth) with it when I used it last year and I am hesitant to go down that path again, especially right now.

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Plus, now that Dexcom has Share built into the receiver, it has been SUCH a valuable tool for me and my family. I even contemplated using my old, out of warranty Animas Ping system so I could have all of my data in one place, but after one day of all of the irritating quick-scrolling and constantly missing my intended mark, I got irritated and used my Medtronic pump again. Not to mention, logging everything into the Medtronic through the Capture option so I could keep complete records was just irritating in itself (not that anyone else should have to do that, but I was just for my own sanity’s sake).

It really baffles me how Medtronic, being the big business that it is, and knowing that not everyone can wear their sensor, wouldn’t work with Dexcom to have a Dexcom version of their pump. Of course, I don’t know if maybe the feeling is mutual between companies and they just don’t want to be friends or what, but it would seem that if a company wanted to reach a HUGE customer base for their combination product, it would offer options that would fit almost everyone’s needs.

Anyway, that’s where I am right now. I have had a good experience over the past month and a half with my Medtronic pump and it’s made handling diabetes with pregnancy since switching a lot easier. I just wish I could have my reports all in one place, instead of two. It helps me make better decisions about my care. Sort of like what having access to Medtronic Pro reports would probably do too, but that’s another beef I have with them ( I mean, seriously?? Why can’t we have access to the more comprehensive stuff if our endo’s trust our judgement? And why have TWO systems anyway – other companies don’t [I don’t think, anyway].)

Bottom line is I know Dexcom works very well for me. I know that I like the Medtronic pump. I just want my world to be perfect and have the option of having those two combined.

*clicking my ruby slippers*

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